Bacteriological and clinical profile of community acquired pneumonia in hospitalised children with associated co-morbidity in a tertiary care centre of Western Rajasthan, India

Authors

  • Yudhavir. S. Shekhawat Department of Pediatrics, AIIMS, Jodhpur, Rajasthan
  • Pramod Sharma Department of Pediatrics, Dr. S. N. Medical College Jodhpur, Rajasthan
  • Anurag Singh Department of Pediatrics, Dr. S. N. Medical College Jodhpur, Rajasthan
  • Vikas Payal Department of Pediatrics, Dr. S. N. Medical College Jodhpur, Rajasthan

DOI:

https://doi.org/10.18203/2349-3291.ijcp20163682

Keywords:

Blood culture, CAP, NPA

Abstract

Background:Childhood community acquired pneumonia (CAP) is a significant problem in developing countries and confirmation of microbial aetiology is important for individual, as well as public health. However, there is paucity of data from the western part of the Rajasthan, India. The study was conducted to obtain comprehensive insight into the bacteriological and clinical profile of community-acquired pneumonia with associated co-morbidity in children requiring hospitalization.

Methods: It was hospital based single centered, observational study. The study enrolled 130 children with CAP over 12 consecutive months from 2013-14, and recorded presenting symptoms, clinical signs, chest radiography and co-morbid conditions. Blood cultures and NPA (nasopharyngeal aspirates) cultures were performed.

Results:We enrolled 130 children. NPA and blood cultures yielded bacteria in only 42 (32.3%) and 29 (22.3%) children respectively. The most common organism isolated on blood culture was Staphylococcus aureus (10%) followed by Streptococcus pneumonia (3.1%). The most common organism isolated on nasopharyngeal aspirate culture was Streptococcus pneumonia (18.5%), followed by Streptococcus aureus. Malnutrition (48.7%) was the most common co-morbidity associated with CAP followed by asthma (3.9%).

Conclusions:The overall rate of identification of bacterial etiology of community acquired pneumonia was low.       S. pneumoniae and S. aureus predominate in NPA and blood respectively. It is reasonable to conclude that S. aureus is the dominant pathogen in CAP in this part of world. Higher rates of isolation of S. pneomoniae from NPA may be because of carrier stage.  

References

Walker CL, Rudan I, Liu L, Nair H, Theodoratou E, Bhutta ZA, et al. Global burden of childhood pneumonia and diarrhoea. Lancet. 2013;381:1405-16.

Rudan I, Brien KL, Nair H, Liu L, Theodoratou E, Qazi S, et al. Epidemiology and etiology of childhood pneumonia in 2010: estimates of incidence, severe morbidity, mortality, underlying risk factors and causative pathogens for 192 countries. J Glob Health. 2013;3:010401.

Nair H, Simoes EAF, Rudan I, Gessner BD, Baumgartner AE, Zhang JSF. Global and regional burden of hospital admissions for severe acute lower respiratory infections in young children in 2010: a systematic analysis. Lancet. 2013;381:1380-90.

Liu L, Oza S, Hogan D, Perin J, Rudan I, Lawn JE, et al. Global, regional, and national causes of child mortality in 2000-13, with projections to inform post–2015 priorities: an updated systematic analysis. Lancet. 2015;385:430-40.

Mathew JL, Patwari AK, Gupta P, Shah D, Gera T, Gogia S, et al. Acute respiratory infection and pneumonia in India: a systematic review of literature for advocacy and action: UNICEF–PHFI series on newborn and child health, India. Indian Pediatr. 2011;48:191-218.

World Health Organization. Technical bases for the WHO recommendations on the management of pneumonia in children at first level health facilities. Geneva, Switzerland: 1991.

World Health Organization (WHO). Department of child and adolescent health and development. (CAH). Integrated management of childhood illness (IMCI) Technical seminar acute respiratory infections. Available at http:/ /www.who.int /maternal_child_adolescent/documents/pdfs/cah_01_10_ts_ari.pdf. Accessed on 10 June 2015.

World Health Organization. Handbook IMCI. Integrated management of childhood illness. Geneva, Switzerland: World Health Organization, 2005. Available at http:// apps.who.int /iris/ bitstream/10665/42939/1/9241546441.pdf. Accessed on 12 January 2015.

Scott JA, Wonodi C, Mosi JC, Deloria KM, Deluca AN, Karron RA, et al. The definition of pneumonia, the assessment of severity, and clinical standardization in the pneumonia etiology research for child health study. Clin Infect Dis. 2012;54(2):109-16.

Gilani Z, Kwong YD, Levine OS, Deloria KM, Scott JA, Brien KL, et al. A literature review and survey of childhood pneumonia etiology studies: 2000–2010. Clin Infect Dis. 2012;54(2):102-8.

Falade AG, Ayede AI. Epidemiology, aetiology and management of childhood acute community acquired pneumonia in developing countries a review. Afr J Med Med Sci. 2011;40:293-308.

Don M, Canciani M, Korppi M. Community acquired pneumonia in children: what's old? What's new? Acta Paediatr. 2010;99:1602-8.

Jaiswal N, Singh M, Thumburu KK, Bharti B, Agarwal A, Kumar A, et al. Burden of invasive pneumococcal disease in children aged 1 month to 12 years living in South Asia: a systematic review. PLoS ONE. 2014;9:96282.

Prajapati B, Talsania N, Lala MK, Sonalia KN. A study of risk factors of acute respiratory tract infection (ARI) of under-five age group in urban and rural communities of Ahmedabad district, Gujarat. Health line. 2012;3(1):16-20.

Kabra SK, Lodha R, Broor S, Chaudhary R, Ghosh M and Maitreyi RS. Etiology of actue lower lespiratory tract infection. Indian J Pediatr. 2003;70:33-6.

Palafox M, Guiscafre H, Reyes H, Munoz O, Martinez H. Diagnostic value of tachypnoea in pneumonia defined radiologically. Arch Dis Child. 2000;82:41-5.

Taylor JA, Beccaro DM, Done S, Winters W. Establishing clinically relevant standards fortachypnea in febrile children younger than 2 years. Arch Pediatr Adolesc Med. 1995;149:283-7.

Deivanayagam N, Nedunchelian K, Ramaswamy S, Sudhandirakannan, Ratna SR. Risk factors for fatal pneumonia: a case control study. Indian Pediatr. 1992;29:1529-32.

Reddaiah VP, Kapoor SK. Acute respiratory infections in under five: experience at comprehensive rural health services project hospital Ballabgarh. Indian J Community Med. 1995;20:1-4.

Kumar A, Sethi GR, Mantan M, Aggarwal SK, Garg A. Empyema thoracis in children: a short term outcome study. Indian Pediatr. 2013;50:879-82.

Goyal V, Kumar A, Gupta M, Sandhu HP, Dhir S. Empyema thoracis in children: still a challenge in developing countries. Afr J Paediatr Surg. 2014;11:206-10.

Hamer DH, Darmstadt GL, Carlin JB, Zaidi AK, Antwi YK, Saha SK, et al. Etiology of bacteremia in young infants in six countries. Pediatr Infect Dis J. 2015;34:1-8.

Agarwal G, Awasthi S, Kabra SK, Kaul A, Singhi S, Walter SD, ISCAP Study Group. Three day versus five day treatment with amoxicillin for non-severe pneumonia in young children: a multicentre randomised controlled trial. British Med J. 2004;328:791.

Jain A, Kumar P, Awasthi S. High nasopharyngeal carriage of drug resistant Streptococcus pneumoniae and Haemophilus influenzae in North Indian school children. Trop Med Int Health. 2005;10:234-9.

Levine OS, Liu G, Garman RL, Dowell SF, Yu S, Yang YH. Haemophilus influenzae type b and Streptococcus pneumoniae as causes of pneumonia among children in Beijing, China. Emerg Infect Dis. 2000;6:165-70.

Downloads

Published

2016-12-22

Issue

Section

Original Research Articles